A place for men to deal with manly
issues in a manly way
The rationale behind Man Therapy
Research into men’s help-seeking behaviour
In May 2012, beyondblue commissioned Hall & Partners|
Open Mind to conduct a market research project into
men’s help-seeking behaviour.1 The research aimed to
build upon what is already known about the barriers
and motivators shaping men’s help-seeking behaviours,
to explore if and how public discourse reinforces the
barriers to help-seeking, and how communications can
be reframed to encourage behaviour change.
The first stage of the qualitative study included in-depth
interviews with health professionals, men who had sought
help and partners/family members of men who had
sought help.
The second stage comprised a combination of 21
discussion groups, 22 in-depth interviews and two online
bulletin boards across six states and territories (including
metropolitan, regional and rural locations).
The outcomes of this research, supported by other studies
into men’s help-seeking behaviour, and an international
collaboration with the Colorado Office for Suicide
Prevention has led beyondblue to launch Man Therapy
– mantherapy.org.au – to coincide with Men’s Health
Week 2013.
Reframing communications
The Hall & Partners | Open Mind research identified an
opportunity to reframe communications to men around
depression and anxiety. Recommendations included:
• Communications need to be logical, factual
and directional; they need to focus on tangible,
actionable elements.
• Provide easy-to-navigate information pathways that
uses video, checklists, and tools, preferably online.
• Provide exposure to real life examples of other men
who have experienced anxiety and depression, not
necessarily celebrities.
To enable men to shift beyond a simple awareness of
anxiety and depression, towards greater understanding of
the conditions, beyondblue needed to focus on developing an
online resource that provided men with three key learnings:
• Know the signs
• Know the range of treatment options
• Develop an action plan.
It was also recognised that for many groups of men within
Australian society, specific strategies and interventions
over and above these methods would be required. Some of
those groups include:
• Aboriginal and Torres Strait Islander men
• men from some culturally and linguistically
diverse backgrounds
• gay and bisexual men, and those from the trans and
intersex communities identifying as male
• men experiencing, or at high risk of, homelessness.
Depression and anxiety in men2
In Australia, one in eight men are likely to experience
depression in their lifetime, and one in five men are
likely to experience anxiety. In a 12-month period,
12.5 per cent of men aged 16 to 54 are likely to have
anxiety and 6.6 per cent of men in this age bracket
are likely to have depression. The highest rates of
depression and anxiety occur in men aged 35 to 44.
Age
Depression
(12-month % of men)
Anxiety
(12-month % of men)
16–24
4.3%
9.3%
25–34
7.0%
11.5%
35–44
8.4%
14.9%
45–54
6.3%
13.9%
• Recognise that the language of ‘help-seeking’ for men
is passive and emasculating, and that ‘taking action’ on
health issues is empowering for many men.
www.beyondblue.org.au
1300 22 4636
1
Men and suicide
33 men die by suicide every week in Australia.3
Suicide is the number one killer of men aged 15 to 44.
In 2011, the highest suicide rates for males was for
those over 80 and those aged 30 to 49.
The rate of suicide for young Australian men (i.e. aged
15 to 24) is half that of men in their middle years.
Suicide ranks second to coronary heart disease
in its contribution to potential years of life lost by
Australian men.4 In 2011, there were 1,727 male
suicides in Australia, compared to 893 males who
died on Australian roads 3, a ratio of almost 2:1.
For every person who dies by suicide, at least six
additional people are profoundly impacted for the rest
of their lives.
Research investigating suicide suggests that mental
illness is present in a high proportion of cases, and
many of these are untreated at the time of death.
The social norms of masculinity play an important
role in the gender differences of suicide. Men have a
greater tendency not to recognise or respond to their
own negative emotions or distress, partly due to the
stigma associated with ‘mental health’, which in turn
may result in clinical depression.5
Through tackling the rate of depression and anxiety in
men, reducing stigma, facilitating a change in men’s
help-seeking behaviour and challenging perceptions
of masculinity, it is believed that a reduction in the
male suicide rate can be achieved.
Avenues for support
For those who had sought help, or in anticipating where one
might seek help, a limited number of key sources emerged
from the research.
The internet is the go-to resource in all aspects in life
and is especially relevant in offering anonymous means
of gathering information. However, information gathering
is based on search engine exploration, not a specific site
or destination.
Family and friends are seen by many as a safe first step,
however not all feel comfortable about making their
vulnerabilities known to their loved ones.
Seeing a General Practitioner is regarded as the first step
in accessing professional help, though for many there are
concerns about medications and trust/privacy, particularly
in rural areas.
A psychologist or psychiatrist is associated with
a ‘serious condition’ and ‘advanced cases’ and is
unimaginable to many men. Also, many men question
the value of sitting and talking.
Telephone support services are seen as a last resort by
many men, and would only be used in a crisis situation.
2
Summary of main findings
Understanding depression and anxiety
In the Australian community, attitudes to mental health
and specifically men’s mental health have shifted
significantly in the last 10 to 15 years.
“My old man would never have talked about this stuff.
You kept your problems to yourself and just got on
with it.”
— Father, 25-49, regional centre VIC
Although society is talking more openly, there is a lag
observed between community and personal attitudes
to mental health and help-seeking – which suggests
communications need to move beyond awareness.
Many men are still hesitant and have difficulty in talking
about anxiety and depression, in part driven by a lack of
understanding about the conditions. They are often grouped
together in a ‘vast unknown’ and lack clear parameters
and easily comprehensible components – the boundary
between ‘feeling depressed’, ‘being depressed’ and ‘clinical
depression’ is unclear.
Perceived and/or actual stigma
For many men, having to ‘admit’ to anxiety or depression (to
family, partner, friends, workmates), means having to let go
of the image one has of oneself.
Anxiety and depression were seen to retain the sense of not
being good enough, strong enough, capable enough to get
through daily life.
“You are the head of the family or the boss in the office
and you have to show you are in control all of the time
and nothing gets you down… and always have a joke or a
smile on your face, even though it is killing you inside.”
— Father, 25-49, regional centre NSW
Many spoke of being worried about what other people
would think, particularly in the workplace, which often
plays an important role in a man’s sense of identity.
“There was no way he’d ever tell work about what he was
going through, he was so fearful of the repercussions,
whether he’d lose his job.”
— Female partner of male with depression, metropolitan VIC
Need for control
There is a strong need among many men to control their
world. This stems from their perceived role as provider and
family head – even among those who share the earning and
child-rearing responsibilities with their partner.
The need for control extended through to engagement
with health professionals. Many men expected that
visiting a General Practitioner would end in a prescription
for medication and that this is the only treatment option
available. There are concerns, even fears, that medication
would result in a loss of control. As a result, some men
avoid going to their GP.
Many men also shy away from the idea of psychological
therapy, which can be viewed as a feminine form of
treatment and as “all talk, no action”.
Partners of men with depression often spoke of their
experience of “speaking to a brick wall”.
“There just isn’t anything I can do. What can you do if
they absolutely don’t want to talk about it?”
— Female partner of male with depression, metropolitan VIC
“Isolation is a big thing for men when they are separated.
Not having someone to talk to. It’s too easy to crack a
beer and all of a sudden you realise you’re knocking
back a carton. Men don’t tend to get out or go on trips or
have the social circles like women do.”
— Father (separated), metropolitan QLD
Where social support does exist, it is important for men
to learn about anxiety and depression so they can support
their mates, and other loved ones. Men do look to their
mates for support.
“I take great pride in knowing that when the chips are
down my mates will be there to help out the same as I
would do for them.”
— Older male, rural township, online forum
Lack of tools
The research found that men often spoke of being illequipped or not having the tools to enable them to discuss
their experiences. Although excessive drinking is often
seen as a sign of ‘something not right’ – and where for
men drinking is a form of coping with emotional distress –
the only way many men feel comfortable to ask a friend if
everything is OK is by going out for a few drinks.
Most men felt uncomfortable to broach the subject with a
mate until it was at crisis point.
Point of action
For many men, depression and anxiety continue to be
associated with weakness, and that is synonymous with
failure. The implication of seeing anxiety and depression as
a weakness is that help-seeking can be seen as a failure to
‘handle the problem’.
“Men in particular are deemed ‘weak’ if suffering and
need to ‘suck it up’.”
— Father, 25-49, regional centre SA
“I’d step in if I thought he was at risk of self-harm.”
— Father, 25-49, regional centre VIC
Partners of those with depression and anxiety acknowledge
that men tend to have more difficulty articulating their
emotional experience.
“I think it’s interesting if you think about the words you
could use for depression… Men just don’t have the
words, they have no vocabulary whatsoever to even
begin to describe what they are going through.”
“[Men seek help] only once they have to, only once it is
inescapable that they are actually suffering from an
illness. Even when diagnosed, denial seems to be the
order of the day.”
— Male, rural township, online forum
Without understanding the signs and symptoms of
depression and anxiety, many men are unlikely to know
when crisis point is reached.
— Female partner of male with depression, metropolitan QLD
Knowledge of the range of treatment options available, and
the relative benefits of each, was also found to be lacking.
Lack of social support and community connections
Seeking help and support can be daunting for someone
who hasn’t taken action before, especially when there is
uncertainty as to what help-seeking looks like and what
kind of supports are available. Having the support and
encouragement of loved ones can be important in assisting
a person to take the first step.
Collaboration with Colorado Office
for Suicide Prevention
In 2007, the Colorado Office for Suicide Prevention,
Carson J Spencer Foundation, and Cactus Marketing
Communications forged a partnership and set out to
uncover a new approach to preventing suicide among
working age men.6
The partnership identified eight approaches to reaching
men, which closely align with the findings of beyondblue’s
own research, and the research more broadly around
perceptions of masculinity and help-seeking behaviours.
Therefore, the absence of support, for example for those in
broken relationships or the socially isolated, is a barrier to
taking action early.
3
Eight approaches to reaching men
• Take the mental health language out of the
communication, at least initially; meaning the removal
of the “if you are depressed seek help” message.
• Show role models of hope and recovery.
• Connect the dots: physical symptoms (changes in
energy, sleep patterns, appetite) with emotional issues.
• Meet men where they are instead of trying to turn them
into something they are not. This is achieved through the
use of humour to start conversations; targeted media;
use of the internet as the primary vehicle.
• Target men who have a range of risk factors, who are
also the least likely to seek support.
• Recognise opportunities to give back (e.g. via family
and community connection) are important factors in
suicide prevention.
• Coach the people around men, including men
themselves, on what to look for and what to do.
• Provide men with at least the opportunity to assess
and ‘fix’ themselves through the provision of simple selfhelp strategies.
The Colorado partnership and beyondblue have been
closely collaborating since the launch of the US version of
Man Therapy (mantherapy.org) in July 2012 to bring Man
Therapy to Australia.
Man Therapy for Australia
Man Therapy, with its central character of Dr. Brian
Ironwood, was launched in June 2013 to coincide with
Men’s Health Week.
In February 2013, beyondblue engaged Ipsos Social
Research Institute (SRI) to evaluate the effectiveness of
Man Therapy in Australia, with the final report delivered
in May 2014.
As part of Ipsos SRI’s evaluations of Man Therapy, a model
review of similar international campaigns was performed.
This identified that Man Therapy should reach around 2530 per cent of Australian males.
cent to 22 per cent. Website users largely indicated that
they found the website useful. Eighty per cent (80%) of
all participants in the survey indicated that the website
provided information that was useful to them, and 55 per
cent felt that the information on the website was new to
them. The impact of the website on visitors’ behaviour
was often to discuss their experiences with others (either
friends and family or health professionals), or to search for
further information. In the fortnight following their visit to
the website:
• 36 per cent had spoken to family or mates
• 29 per cent had visited a GP
• 23 per cent had visited a psychologist or psychiatrist
• 21 per cent had looked for further information.
Ensuring continued campaign reach
One of the main recommendations from Ipsos SRI’s
campaign evaluation was that continued spend on the
campaign and further creative development would be
necessary to improve results, in terms of reach, improved
knowledge, attitudes or behaviour.
To support these objectives, further research into how
Man Therapy could continue to engage Australian males
was conducted though TNS in late 2014. This research
highlighted potential signs of campaign ‘wear out’ and an
opportunity to target different segments of the audience.
Following these findings, a new character, ‘Davo’, was
developed to reinvigorate the campaign and introduce
Man Therapy to even more men. Qualitative research
and concept testing was completed in January 2015, with
another round of testing in March 2015 to explore, report on
and refine creative messages.
The next phase of the campaign launched in June 2015.
It revolves around Davo, who presents the Man Therapy
website (www.mantherapy.org.au/davo) and delivers
information and advice in a down-to-earth, relatable and
no-nonsense manner. The campaign encompasses TV,
radio and digital and runs over an extended period of six
months.
Post-campaign results show that Man Therapy exceeded
expectations regarding campaign reach. Campaign reach
among males in the post-campaign survey was 43 per
cent. This means that approximately 3,420,000 Australian
men aged 18+ saw one or more of the Man Therapy
advertisements.
Positively, campaign reach was highest amongst men who
had experienced signs and symptoms of anxiety.
Participants’ responses to the advertising materials was
resoundingly positive. The majority of those who had seen
or heard the ads, featuring Dr. Brian Ironwood, indicated
that they thought the advertisements raised an important
issue, were attention grabbing, and that they liked the guy
featured in the ads.
Exposure to Man Therapy advertising materials also had
a distinct positive effect on awareness of mantherapy.
org.au. Between the benchmark and post-campaign
surveys, awareness of the website increased from 2 per
A creative asset from the latest campaign, featuring Davo.
www.beyondblue.org.au
1300 22 4636
Man Therapy fits within the frame of the latest research
on combating stigma, through increasing contact between
the community and people who have experienced, and
effectively managed, depression and anxiety. This contact
needs to be targeted, localised, credible and continuous to
have a chance in attitudinal and behaviour change.
Project partners
beyondblue
beyondblue is an independent, not-for-profit
organisation working to promote good mental health.
beyondblue creates change to protect everyone’s
mental health and improve the lives of individuals,
families and communities affected by depression,
anxiety and suicide, so that all people in Australia
achieve their best possible mental health.
Marmalade Melbourne helped beyondblue adapt Man
Therapy for Australia, through the fictional characters of
Dr. Brian Ironwood and Davo. The target audience is the 5.5
million men aged 18 to 54 in Australia, in particular: young
men aged 18 to 24, fathers aged 25 to 54, men living and
working in urban growth areas, men living and working in
regional and remote areas, men who are unemployed and
men misusing alcohol and drugs as coping mechanisms.
Colorado Office for Suicide Prevention,
Cactus Communications and the
Carson J Spencer Foundation
beyondblue’s existing project, The Shed Online
(www.theshedonline.org.au) has been externally evaluated
and found to be an effective online resource for reaching
men aged over 55, and beyondblue will continue to provide
this platform for older men to explore the issues of anxiety
and depression.
Part of a multi-agency effort, including the Colorado
Office of Suicide Prevention, Carson J Spencer
Foundation and Cactus, Man Therapy is giving men
a resource they desperately need. A resource to
help them with any problem that life sends their way.
Something to set them straight on the realities of
suicide and mental health, and in the end, a tool to
help put a stop to the suicide deaths of so many of
our men.
Hall & Partners | Open Mind
Hall & Partners | Open Mind is a specialist
communications research agency with a wealth
of experience in social policy and government
communications research. The agency’s team, led
by Dr Vicki Arbes, conducted both the qualitative
research into men’s help-seeking behaviours and
concept testing of Man Therapy.
The ‘Men’s Help Seeking Behaviour’ report
is available on the beyondblue website at
www.beyondblue.org.au/mantherapy
Marmalade Melbourne
Marmalade Melbourne is team of creative and digital
advertising specialists determined to offer clients
fresh and effective communications. Marmalade
comprehensively recreated Man Therapy for the
Australian market.
Hall & Partners | Open Mind, Men’s Help-Seeking Behaviour Report of
Research Findings, September 2012
1
Australian Bureau of Statistics, National Survey of Mental Health and
Wellbeing, 2007, Catalogue Number 4326.0, 2008
2
Australian Bureau of Statistics, Causes of Death Australia 2011, preliminary
data, Catalogue Number 3303.0, 2013
3
Australian Institute of Health and Welfare, Australia’s health 2010,
Canberra, 2010, cited in Beaton, S. and Forster, P., 2012, ‘Insights into
men’s suicide’, Australian Psychological Society, www.psychology.org.au/
insych/2012/august/beaton
4
Beaton, S. and Forster, P., 2012, ‘Insights into men’s suicide’,
Australian Psychological Society, www.psychology.org.au/insych/2012/
august/beaton
5
Colorado Office for Suicide Prevention, Man Therapy: an innovative
approach to suicide prevention; White Paper, July 2012
6
www.beyondblue.org.au
1300 22 4636
© Beyond Blue Ltd. BL/1098 06/15